Childhood Trauma, Depression Associated With Impaired Quality of Life in Schizophrenia

Although caregiver interventions may be especially important in patients with schizophrenia with high positive symptoms, targeting negative symptoms may be more effective in improving patients' QoL.

Researchers from the FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group have found that depression was again confirmed as the strongest association with reduced quality of life (QoL) in schizophrenia; however, childhood trauma was also associated with impaired quality of life in schizophrenia and should be considered when implementing therapies intended to improve QoL.1

Meja Andrianarisoa, MD, from the Fondation FondaMental in Créteil, France, and colleagues enrolled a sample of 544 community-dwelling, stabilized patients with schizophrenia from the FACE-SZ cohort into the study. The mean age of the participants was 32.3 years, mean illness duration was 10.6 years, and 74.1% of the sample were men.

Researchers measured childhood trauma with the Childhood Trauma Questionnaire, depression with the Calgary Depression Rating Scale for Schizophrenia, and psychotic severity with the Positive and Negative Syndrome Scale for Schizophrenia; they also measured other clinical factors, treatments, comorbidities, functioning, and sociodemographic variables.

The researchers found that of the 544 individuals enrolled, 151 participants (27.8%) had a current major depressive episode, and 406 (82.5%) reported at least 1 episode of childhood trauma; 43.9% of participants reported emotional abuse in childhood, 20.2% reported sexual abuse, and 20% reported physical abuse. The researchers noted that these results were comparable to a previous study conducted by Ilaria Bonoldi, MD, and colleagues in 2013.2

In multivariate analyses, a lower QoL total score was associated with a history of childhood trauma, psychotic negative symptoms, current depression, and male sex.

The researchers noted that their study also matches results from a study conducted by Gagan Fervaha and colleagues in 2013, based on the CATIE study, showing that impaired QoL is associated with depression. This strongly suggests that depression is significantly associated with impaired QoL in schizophrenia.3

"The present study confirms that major depressive episodes should be systematically assessed and specifically treated in [schizophrenia]," the authors wrote. "Depressive symptoms including sadness, hopelessness, and suicidal ideation should be specifically targeted independently of negative symptoms (including blunted affect, social withdrawal, and avolia)."

The researchers also found that not all psychotic symptoms affect QoL equally; they found that positive symptoms negatively affected family relationships, but negative symptoms such as depression worsened friendships and psychological well-being. "This is consistent with previous findings suggesting that helping caregivers manage their relative's positive symptoms may improve family burden and [schizophrenia] outcome,"the authors wrote.4

Clinical Applications

On the basis of results from this FACE-SZ cohort study, the researchers suggest that caregiver interventions may be especially important in patients with schizophrenia with high positive symptoms, whereas targeting social skills and psychological well-being in patients with high negative symptoms, such as depression or history of childhood trauma, may be more effective in improving patients' QoL.

Limitations

History of childhood trauma is also associated with posttraumatic stress disorder (PTSD) but was not evaluated in this study. PTSD should be evaluated in future studies.

The rate of childhood trauma is very high in this study, possibly because even mild childhood trauma such as mild emotional neglect was included.

A causal inference between childhood trauma and schizophrenia cannot be made and should only be viewed as an association.

There has been a question of whether antipsychotic medications are truly acting upon "primary" negative symptoms, or whether they are instead improving "secondary" negative symptoms via improvement in positive or ...